FULL_TIME

FEED

UNKNOWN

The investigator analyzes claims, encounter, enrollment, medical record, and provider data; conducts interviews, field investigations, and on-site audits, when necessary; prepares detailed investigative reports; and collaborates with compliance, legal, operational stakeholders, regulatory agencies, and law enforcement. Responsibilities: The SIU Fraud Investigator is responsible for identifying, investigating, and resolving allegations and indicators of fraud, waste, and abuse (FWA) involving providers, vendors, members, and other parties participating in Elderplan’s product lines.

YEAR

Metropolitan Jewish Health System

Fraud Investigator

[AW]-iCims

Pursuant to the New York State Public Officers Law & the MTA Code of Ethics, all employees who hold a policymaking position must file an Annual Statement of Financial Disclosure (FDS) with the NYS Commission on Ethics and Lobbying in Government (the "Commission"). As an employee of MTA NYC Transit, you may be required to complete an annual financial disclosure statement with the state of New York, if your position earns more than $101,379 (this is subject to change) per year or if the position is designated as a policy maker.

<p>Metro is unique among the nation’s transportation agencies. We serve as transportation planner and coordinator, designer, builder, and operator for the country’s largest, most populous county. More than 10 million people – nearly one-fourth of California’s residents – live, work and play within our 1,433-square-mile service area.</p>

Metropolitan Transportation Authority

Claims Fraud Investigator

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Communication skills: Ability to interact professionally and effectively with all levels of staff including AUSAs, support staff, client agencies, debtors, debtor attorneys and their staff, court personnel, business executives, witnesses, and the public. The candidate must take the initiative to ask questions to successfully complete tasks, perform detailed work consistently, accurately, and under pressure, and be enthusiastic about learning and applying knowledge to provide excellent litigation support to the client.

CONTACT GOVERNMENT SERVICES

Healthcare Fraud Investigator

The Metropolitan Transportation Authority is North America's largest transportation network, serving a population of 15.3 million people across a 5,000-square-mile travel area surrounding New York City, Long Island, southeastern New York State, and Connecticut. Pursuant to the New York State Public Officers Law & the MTA Code of Ethics, all employees who hold a policymaking position must file an Annual Statement of Financial Disclosure (FDS) with the NYS Commission on Ethics and Lobbying in Government (the "Commission").

Supervising Claims Fraud Investigator

Associate or bachelor's degree in criminal justice or related field, OR five years of insurance claims investigation experience, OR professional investigation experience with law enforcement agencies, OR seven years of professional investigation experience involving economic or insurance related matters. Verify receipts, complete activity checks, and other investigative processes with SIU resource materials such as cameras, computers, and recorders.

NYCM Insurance

Fraud Investigator (Hybrid)

The Fraud Investigator plays a critical role in protecting the financial assets, operational integrity, and reputation of Nymbus clients by leading advanced investigations into complex and high-impact fraud cases across multiple payment channels and products. We expect team members to engage in our global community, proactively build relationships, participate actively in team and company conversations, seek opportunities to collaborate, and take shared ownership of creating a connected and inclusive remote community including showing up on camera.

Nymbus, Inc.

Collaborates with internal business partners, compliance, legal, provider and payment integrity teams, and external agencies to coordinate investigative activities, support corrective actions, recoveries, and case resolution efforts. 2+ years Fraud, waste, and abuse investigations, healthcare investigations, claims audits, payment integrity, healthcare compliance, law enforcement investigations, or a related investigative field required.

Centene Management Company

SIU Investigator

Centene Corporation Group

Acquire and gather information through use of own discretion, and guidance from clients and case managers, by means of data collection, interviews, research and collaboration with other SIU entities, law enforcement and state Departments of Insurance. High School diploma or higher with a minimum of five (5) years of demonstrated professional law enforcement experience with specific attention to investigations related to fraud.

HOUR

Allied Universal provides unparalleled service, systems and solutions to the people and business of our communities, and is North America's leading security services provider. With over 140,000 employees, Allied Universal delivers high-quality, tailored solutions, which allows clients to focus on their core business. For more information: 866.825.5433 or <a href="http://www.aus.com/" target="_blank">www.AUS.com</a>


Allied Universal

SIU Investigator - Part Time

4+ years of experience as a Private Investigator, Private Detective, Licensed Investigator, Fraud Investigator, Insurance Investigator, or another closely related investigative role. Experience gathering, analyzing, and compiling information on legal, financial, or personal matters, including background checks, surveillance, interviews, and records research.

Mercor

Private Investigator - AI Evaluation

Manatal

Claim Investigators validate the facts of loss for Insurance claims through scene Investigations, claimant and witness Interviews, document retrieval and data Interpretation. Associate’s degree in Criminal Justice with a minimum of four (4) years of demonstrated experience conducting complex insurance investigations or adjusting complex claims.

Claims Investigator

Routinely handles cases that are sensitive or high profile, those that are complex cases involving or cases involving multiple perpetrators or intricate healthcare fraud schemes. Demonstrates high level of knowledge and expertise during interactions and acts confidently when providing testimony during civil and criminal proceedings.

<p>CVS Health offers a world of promising job opportunities across a diverse range of careers in everything from corporate and pharmacy roles to retails positions. No matter where you work at CVS Health, your unique skills, talents and abilities are welcome and valued. We recognize and reward greatness and want our employees to know their work is making a difference in the lives of millions. Join us today. Together we can continue making innovative, high-quality health and pharmacy services safe, affordable and accessible – for all. </p>

CVS Health Corp

Senior Investigator, Special Investigations Unit (Aetna SIU)

Function: Assists the Senior Financial Intelligence Group (FIG) Investigator II in performing investigations for unusual/suspicious activity to ensure S&T Bancorp, Inc (S&T) operates in accordance with federal and state laws and regulations related to the Bank Secrecy Act (BSA), Anti-Money Laundering (AML) rules, USA PATRIOT Act (USAPA), the Anti-money Laundering Act of 2020 and Office of Foreign Assets Control (OFAC) to protect the Bank from legal/compliance, reputation, and transaction risk. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information.

S&T Bank

FIG Investigator

We are seeking a dedicated and experienced Registered Nurse - Nursing Home Surveyor/Complaint Investigator to join our team in New York City, NY (Bronx, Kings, Richmond, Manhattan, and Queens). This role is a temporary-to-permanent position that involves conducting surveys, complaint investigations, and surveillance activities at nursing homes to ensure compliance with Federal and State regulations.

GreenLife Healthcare Staffing

Registered Nurse - Nursing Home Surveyor/Complaint Investigator

Crelate

Working at Resorts World: Resorts World New York City strives to provide our guests with world-class gaming, exquisite dining, and unique entertainment experiences. Ability to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions, and decimal, and work with mathematical such as probability and inference.

Resorts World Las Vegas

AML Compliance Investigator

Performs sophisticated analyses of large-scale hard-copy and electronic data, such as health care claims data, financial transaction data, accounting records, or bank records to develop investigative leads and to determine their potential relevance to the allegations at issue. Skills and attributes for success: The investigator will generate new investigations, and to continue with ongoing investigation and civil actions involving fraud in areas such as healthcare, contracting, and grants, as well as other fraud and abuse of federal public funds and programs.

Affirmative Civil Enforcement (Ace) Investigator

When determining a team members base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity). Investigations may include, but are not limited to Medicare fraud, financial crimes, internal thefts, identity theft, drug diversions, prescription fraud, or crimes against employees or organization guests.

Northwell Health Inc

Senior Security Investigator

Adobe's industry-leading offerings including Adobe Acrobat Studio, Adobe Express, Adobe Firefly, Creative Cloud, Adobe Experience Platform, Adobe Experience Manager, and GenStudio enable people and businesses to turn ideas into impact, powered by AI and driven by human ingenuity. Through threat intelligence, reverse engineering, technical investigations, detection engineering, and AI-driven capabilities, the team delivers actionable intelligence and scalable mitigations that strengthen platform resilience and protect Adobe, its customers, and its ecosystem.

Adobe is the global leader in digital marketing and digital media solutions. Our tools and services enable our customers to create groundbreaking digital content, deploy it across media and devices, measure and optimize it over time, and achieve greater business success. We help our customers make, manage, measure and monetize their digital content across every channel and screen.  </p>  <h2>Digital media</h2><p> Adobe helps creative professionals, publishers, developers, and businesses create, publish, promote, and monetize their content anywhere.</p> <h2>Digital marketing</h2><p> Our digital marketing solutions combine content and data, personalization, experience management, and social capabilities so businesses can move faster from data to insights to action. </p>

ADOBE Inc

Threat Intelligence / Reverse Engineering Investigator

Albany, NY; Albuquerque, NM; Anchorage, AK; Ashburn, VA; Atlanta, GA; Austin, TX; Baltimore, MD; Baton Rouge, LA; Bentonville, AR; Birmingham, AL; Boise, ID; Boston, MA; Boulder, CO; Buffalo, NY; Charlotte, NC; Chicago, IL; Cincinnati, OH; Cleveland, OH; Columbus, OH; Dallas, TX; Denver, CO; Des Moines, IA; Detroit, MI; El Segundo, CA; Fort Worth, TX; Ft Lauderdale, FL; Greenville, SC; Harrisburg, PA; Hartford, CT; Honolulu, HI; Houston, TX; Indianapolis, IN; Irvine, CA; Jackson, MS; Jacksonville, FL; Kansas City, MO; Knoxville, TN; Las Vegas, NV; Lincoln, NE; Los Angeles, CA; Louisville, KY; McLean, VA; Melville, NY; Memphis, TN; Miami, FL; Milwaukee, WI; Minneapolis, MN; Montvale, NJ; Morristown, NJ; Nashville, TN; New Orleans, LA; New York, NY; Oklahoma City, OK; Omaha, NE; Orlando, FL; Philadelphia, PA; Phoenix, AZ; Pittsburgh, PA; Portland, OR; Providence, RI; Raleigh, NC; Richmond, VA; Rochester, NY; Sacramento, CA; Salt Lake City, UT; San Antonio, TX; San Diego, CA; San Francisco, CA; San Juan, PR; Santa Clara, CA; Seattle, WA; Shreveport, LA; St Louis, MO; Stamford, CT; Tallahassee, FL; Tampa, FL; Tempe, AZ; Virginia Beach, VA; Washington, DC; Winston-Salem, NC. Exceptional verbal/written communication, collaboration, presentation, and negotiation skills to lead case management and adjudication in an environment driven by customer service, high quality, and teamwork; capable of building strong professional relationships with ability to influence all levels across the organization; able to set and execute strategic initiatives for team; creative thinker with ability to identify innovative business solutions; ability to develop strategic organization and resource plans, defining next generation business and leadership needs.

Fraud Investigator Jobs in New York

Fraud Investigator Metropolitan Jewish Health System

Claims Fraud Investigator Metropolitan Transportation Authority

Healthcare Fraud Investigator CONTACT GOVERNMENT SERVICES

Supervising Claims Fraud Investigator Metropolitan Transportation Authority

Fraud Investigator (Hybrid) NYCM Insurance

Fraud Investigator Nymbus, Inc.

SIU Investigator Centene Management Company

SIU Investigator Centene Corporation Group

SIU Investigator Allied Universal

SIU Investigator - Part Time Allied Universal

Private Investigator - AI Evaluation Mercor

Claims Investigator Allied Universal

Senior Investigator, Special Investigations Unit (Aetna SIU) CVS Health Corp

FIG Investigator S&T Bank

Registered Nurse - Nursing Home Surveyor/Complaint Investigator GreenLife Healthcare Staffing

AML Compliance Investigator Resorts World Las Vegas

Affirmative Civil Enforcement (Ace) Investigator CONTACT GOVERNMENT SERVICES

Senior Security Investigator Northwell Health Inc

Threat Intelligence / Reverse Engineering Investigator ADOBE Inc

Temporary Manager, Personnel Background Investigator KPMG International Cooperative

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